Because of the recent discovery that there may be substantial, life-threatening side effects to some vaccinations in cats, legal counsel recommends a consent form for all such vaccinations. The panel has included these examples for consideration to better inform clients and to protect practitioners.

The consent form should be titled "Consent to Vaccination" or something similar that clearly expresses the purpose of the document. The body of the document should describe the disease being vaccinated against, the odds of the cat contracting that disease (if known), the benefits to the cat of vaccination against that disease, the expected side effects of vaccination, and the odds of the cat developing any particular side effect. The document should also include the veterinarian's name, the clinic name and address, the client's name and the name of the animal being vaccinated. The document should conclude with a statement of understanding and consent, and dated blocks for the client and veterinarian to sign.

ADDRESS

CITY, TOWN

CONSENT TO VACCINATION(a)

I hereby consent to have my cat (State Cat's Name) vaccinated for (State Disease). I have read and understood to my satisfaction the materials provided to me by Dr. (State Name). He/she has answered, to my satisfaction, all my questions. I am aware of the potential benefits and significant risks of vaccinating (State Cat's Name) against (State Disease).

(a)This model is an example of an informed consent form. It is presented as educational material and should not be considered, in any way, as legal advice. Veterinarians should submit any proposed informed consent form to an attorney familiar with local informed consent rules before using: such a form in their practices.

This form assumes that the veterinarian has some form of written material to give to the client and that the material is in a form and language that the client can understand.

It is important that the written materials be provided to the client far enough in advance of the client's consent for the client to have read and understood them. Materials handed to the client with or after the consent are not considered part of the information required for an informed consent.

ADDRESS

TOWN, STATE

CONSENT TO VACCINATION (b)

The goal of animal vaccination is to effectively reduce the extent and severity of infectious disease in our pets.

In granting this consent to vaccinate I hereby state that:

1. I understand that (Cat's name) may be exposed to (Disease).

2. I understand that vaccination of (Cat's Name) with (State Name & Type of Vaccine) will substantially reduce but may not completely eliminate his/her chances of contracting (Disease).

3. I understand that (Cat's Name ) may develop ( List Side Effects ) after vaccination. I understand that these side effects are usually minor and pass without the need for additional veterinary care. I understand that should ( Cat's Name ) develop any severe or unanticipated reaction to the vaccination I should contact (State Who to Contact and How) immediately for instructions.

4. I understand that (Cat's Name) has a (State Current Best Estimate of Odds) chance of developing a sarcoma (a type of tumor) at the vaccination site. I understand that this type of tumor, should it occur, is life-threatening and may require extensive medical or surgical treatment.

5. I have had an opportunity to ask any questions I have concerning this vaccination. All such questions have been answered to my satisfaction.

Date:                                                           Owner's Signature:

Date:                                                           Witness Signature: